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Theres always this black box between what people say they eat or take and what is actually absorbed, said Regan Bailey, an associate professor of nutrition science at Purdue University and a former nutritional epidemiologist with the National Institute of Healths Office of Dietary Supplements

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One area of ongoing debate is whether persistent symptoms reflect ongoing infection, residual tissue injury, immune dysregulation, untreated co-infections, autonomic dysfunction, or a combination of these factors

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Inclusion criteria: all participants must: be 65 years of age be attending a primary healthcare centre for consultation on some medical matter provide their informed consent to be included have a serum B12 concentration of 200 pg/ml at 4 months in over 70% of patients

A finer needle causes less discomfort